The Difference Between Inpatient and Outpatient Treatments you need to know for Health Insurance

difference between inpatient and outpatient

Explore the difference between inpatient and outpatient treatments

When considering any kind of individual or company health insurance plan, it is important to understand the breakdown of your cover. Otherwise, what is it exactly you are putting your money into?
The important thing to remember is that private medical insurance is broken down into three parts: in/day-patient, out-patient, and other additional benefits.
We are all individuals with complex and differing needs, so our insurance plans must be tailored to reflect this.
To create and choose a personalised health insurance that best suits you, each section needs exploring, including the differences between in-patient and out-patient treatments.

What is Private Medical Insurance?

Private medical insurance (PMI) is health insurance set up to cover employees for the treatment of acute medical conditions (curable conditions that respond to active treatment).
PMI is targeted at individuals as it provides so many options for specific needs and requirements. You can shape your insurance plan distinctly to you.
As PMI is set up for expenses in the private sector, it is commonly misbelieved that it replaces the NHS. However, instead of taking away from the National Health Service, the two often work together. Employees might start by consulting with the NHS, and then be recommended to a private specialist to gain the best support possible!

What is inpatient treatment?

In-patient treatment is when you are admitted to hospital and have a bed for at least one night.
These treatments are considered as the basics that PMI providers will offer, as the procedures and care are considered the costliest. These include surgery, accommodation, expensive medical tests and after care.
Treatments that can come under in-patient include:

  • Private hospital accommodation costs
  • Drugs/dressings
  • Specialist fees
  • Anaesthetic fees
  • Prosthesis
  • Cancer drugs & biological therapies
  • Diagnostic tests / scans
  • Operations & surgeries

Day-patient treatment; where a person is admitted to hospital and occupies a bed but doesn’t remain overnight, is also included alongside their in-patient benefit.

What is outpatient treatment?

Out-patient treatment is when you visit a hospital or clinic for an appointment, but where you do not need to occupy a bed.
Compared to in/day-patient cover, out-patient treatments are often a modular item which can be selected if you choose, and at varying levels. If it is included, there can be limits applied meaning it is important to check through your chosen plan in detail to see which out-patient treatments you are covered for, and to what degree.
However, once your out-patient cover runs out, you must pay for any treatments yourself or go via the NHS.
Treatments which can be included under out-patient include:

  • Consultations with a specialist
  • Diagnostic tests e.g., blood tests, x-rays
  • Diagnostic scans e.g., MRI, CT, PET
  • Radiotherapy / chemotherapy
  • Physiotherapy
  • Chiropractic
  • Psychiatric / mental health

In-patient and out-patient procedures can become blurred, and it is possible that after being diagnosed through appointments and tests, you are then referred to hospital with the possibility of becoming an in-patient.

Do you need outpatient cover as much as inpatient?

PMI prioritises in-patient procedures due to the severity in price and risk. Even if you don’t have out-patient cover, the policy will typically still include cover for in-patient treatments as a base.
If your plan doesn’t cover outpatient treatments, then you will have to rely on the NHS or self-fund. This is not necessarily a bad thing, but having no outpatient cover slows down the whole process.
However, there are options for mid-range plans, where you select a limited level of out-patient cover. For example, health insurance provider Bupa offers a range of prices for the inclusion of out-patient care: £500, £750, £1000, or full cover. This allows customers to tailor their benefit level to their budget.

Other benefits that come under Health Insurance

It is important to recognise the differences between in-patient and out-patient treatments, and what they can both offer. But there are also extra benefits that providers can offer to sway you towards their plans.
These could include:

  • Virtual GP / GP helpline
  • Private prescriptions
  • Home nursing
  • Private ambulance
  • NHS cash benefit
  • Optical & dental cover
  • Travel cover
  • Health screening

These extra benefits could be the deciding factor for which plan and provider you choose.

Things that are not covered by either in-patient or out-patient (or under general PMI)

Both in-patient and out-patient treatments offer different things, but there are certain general exclusions which are not covered on a PMI plan.
Listed below are other examples:

  • Chronic conditions (conditions that cannot be cured and can only be routinely maintained)
  • Routine pregnancy
  • Congenital conditions
  • Accident & emergency
  • Planned overseas treatment
  • IVF & infertility treatments (unless advised)
  • Gender reassignment (although some large corporate clients are considering this)
  • Cosmetic treatments

This is important to know when exploring different private health insurances. Go check out our other tips for buying PMI!

Why do people get Private Medical Insurance?

With the UK already having the privilege of the NHS, private medical insurance has been considered a luxury in the past.
However, there are reasons why people invest in PMI, ranging from the basics of speedy treatment and no waiting lists to being offered a higher level of choice e.g., preferred hospital or doctor.
PMI enables employee’s to access treatment quickly and conveniently when confronted with medical issues, and has become one of the most popular employee benefits as a result.
Now with an understanding of the basics of private medical insurance, you can make an informed decision on which plan is best suited to you. The modularity of policies means that if you want more emphasis on mental wellbeing services or if physiotherapy is at the top of your list, you can tailor your plan to match!
Either contact us through Engage Health Group or go check out our breakdowns of insurance providers, where we can help you decide which plan is best for you! We are happy to give you free no-obligation advice.

Eleanor Chilvers

Eleanor Chilvers

Eleanor started at Engage in 2021, and is now a Digital Content Writer after studying BA English Literature at University of Sussex for the last 3 years.

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